HELP! What can we do...
lnelson
670 Posts
This will be a long post - Sorry in advance.
We HAD an ee who had injured his shoulder in January was receiving care from a clinic we sent him to. After the second visit to the doctor the doctor calls and speaks with me stating that he believes the ee is faking the injury and to monitor him until his next visit next week. This was on 2-4-04, so we monitored him for 2 days did not notice any problems was doing his work not complaining, nothing. The following week ee does not show up to work no call nothing for over a week so we terminate for job abandonment. A week later we receive a doctor notice from another Dr. stating the ee is totally incapacitated.
How do we handle this? Our carrier says they had dealings with the new doctor and they have never won a case, they seem to be giving up. The ee was not under our care for the allotted time and did not speak to us prior to departure regarding the clinic we sent him to just no shows for next 3 appts that were set up for him.
He is also now complaining of neck, shoulder and back pains. WHAT?? x:o
I am confused to say the least my Safety Director and I are not sure where to go from here.
Give me your thoughts, PLEASE.
Lisa xflash
We HAD an ee who had injured his shoulder in January was receiving care from a clinic we sent him to. After the second visit to the doctor the doctor calls and speaks with me stating that he believes the ee is faking the injury and to monitor him until his next visit next week. This was on 2-4-04, so we monitored him for 2 days did not notice any problems was doing his work not complaining, nothing. The following week ee does not show up to work no call nothing for over a week so we terminate for job abandonment. A week later we receive a doctor notice from another Dr. stating the ee is totally incapacitated.
How do we handle this? Our carrier says they had dealings with the new doctor and they have never won a case, they seem to be giving up. The ee was not under our care for the allotted time and did not speak to us prior to departure regarding the clinic we sent him to just no shows for next 3 appts that were set up for him.
He is also now complaining of neck, shoulder and back pains. WHAT?? x:o
I am confused to say the least my Safety Director and I are not sure where to go from here.
Give me your thoughts, PLEASE.
Lisa xflash
Comments
If he is incapacatated, and he has filed a claim, he will get time loss until the doctor says he is fixed and stable. It is harder to manage people no longer employed at the job of injury, so keep a tight rein on the claim. You might want to check his application to determine if he has other job experience in case he tries to go the voc rehab route. The faster you can show him employable, the quicker the time loss ends. If you cut ties with him, you might also want to put surveillance on him to determine if he is truly injured.
Good luck
How can we do that when the work comp carrier is pretty much given up. They have put the claim on HOLD which is good but I do not know what they are doing.
California workers compensation is soooo out of whack these days.
We have 1 doctor say nothing is wrong and another doctor saying totally incapacitated.
We need to get a third doctor to confirm or deny 1 of the other doctors.
The ee was termed for no show no call. When he came in yesterday he wanted us to fill out some papers and he was asked why he did not call or come in he said his new doctor told him not to come in but that was already after missing a full week. According to doctor's note dated 2-13-04.
I just don't want this to get out of hand.
Lisa
My $0.02 worth.
DJ The Balloonman
I agree with your first assumption.
My Safety Director has been in constant contact with the carrier and I will ask him to ask those questions and make sure that they stay on top of it.
I agree it may be worth the investigator but are they admissable(is that a word?)as evidence? Does the carrier do it or the er? I have never had a case so blatant.
Lisa
Of course, I don't understand California WC. Maybe you can't request an IME.
Just some thoughts.
My $0.02 worth.
DJ The Balloonman
If I'm always logical, then there would be no deviation in my behavior; therefore, not qualifying under 'reasonable suspicion.' Dang, there I go again!
Don't know what came over me. Maybe a puff of second-hand something.
Consider investigation, but realize that W/C is heavily weighted in favor of the employee. An investigator still may not get what you're after.
Now, for the W/C. Get a good investigator, do an activity check first then do a subrosa. Make sure that the investigative company looks for possible permits that this person has gotten for home improvments, opening a business, etc.
Has the employee retained legal representation? if so, then referr this case to your W/C attorney and have him/her work this claim agressively.
Again, do not let the Insurance company throw away your money. You are the customer, you can dictate pretty much what to do and how to do it. DON'T GIVE UP... Yes it's California but you can still work the system, it's in the know how.
Our W/C carrier has referred the ee to another doctor for a third opinion in order to decifer the differences between the other 2 doctors.
Hopefully, this will be the kicker.
Lisa